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“Health care providers need certainty about federal policy,” said Chip Kahn, president and CEO of the Federation of American Hospitals. “Looking beyond the next few days, Congress needs to find a more rational way of setting policy — particularly for something as important as health care.”

The tentative deal shaping up would solve one problem — temporarily. Doctors are facing a nearly 27 percent cut in Medicare payments in January — another yearly collision with the flawed payment formula known as the Sustainable Growth Rate, or SGR. The fiscal cliff package being negotiated would include another one-year “doc fix” — but as of late Monday afternoon, Hill and K Street sources said there was no agreement on how to pay for that patch. Twenty-six billion dollars is needed for the doctors and a few billion more for some other small expiring Medicare provisions that may be extended, such as therapy caps and provisions for rural hospitals.

If the deal collapses, the physician fee cut would again loom. Congress would then have to come up with some kind of solution in the next month or two. While doctors wait for that, Medicare officials can order bill processing to be slowed down — although they haven’t done so yet this year and in recent memory, haven't done that for more than a few weeks. Slowing down the bills may spare doctors the huge cut while Congress wrangles — but it adds to the anxiety. Plus, delayed payments can create cash flow problems for some medical practices.

Congress’s ad hoc yearlong solutions don’t alleviate the uncertainty physicians face as they make decisions about, for instance, whether to take new Medicare patients. Nor does a one-year fix resolve the annual crisis created by the broken formula in the first place.

For the rest of the health care system, the big question is sequestration — the automatic spending cuts that start to go into effect if Congress doesn’t stop them. And the impact of those cuts on health care is quite varied. Some agencies are going to face deep cuts — and others, including Medicare and Medicaid, may end up doing better under sequestration than they would with whatever eventually takes its place.

When the White House cut the debt ceiling deal in mid-2011, which led to the sequestration mess, it drew a line around several health and safety net programs. Medicaid and the Children’s Health Insurance Program are basically untouched by the automatic cuts. Medicare cuts are limited to 2 percent for providers, including doctors, hospitals and the private plans that take part in Medicare Advantage and the Medicare Part D prescription drug programs.